While defending her title at the 2009 Ironman 70.3 World Championships in Clearwater, Florida, former Olympian and professional triathlete Joanna Zeiger reached out from her bike to grab a water bottle from a volunteer’s outstretched arm. The handoff failed. Zeiger was pulled from her bike and crashed to the pavement. The doctor’s initial diagnosis: a fractured clavicle and possible broken ribs.

Within days of her accident, Zeiger was in surgery. Her clavicle healed quickly, but her ribs required six operations over the next seven years.

From the start, Zeiger was prescribed narcotics—Percocet and codeine at first, Vicodin and Dilaudid later—to manage the pain. “At the time, I thought the drugs would be a finite issue just to deal with the postoperative pain,” she recalls. But when it became clear that neither her pain nor her opioid prescription was short term, she decided to avoid taking the medications.

Zeiger is like many athletes, professional and amateur, who suffer from acute or chronic pain, and who as a result readily receive narcotic prescriptions. “My reluctance [about taking the drugs] stemmed from knowing too many people who became addicted and reading stories about professional athletes who needed rehab for an addiction that began with an injury,” she says.

Statistics on use and abuse of prescription pain medications specifically among athletes are hard to come by, but a 2014 study in the Journal of Adolescent Health reported that males who participate in sports have greater access to and are more likely to abuse prescription narcotics than their non-athlete counterparts. The NCAA reports that nearly a quarter of all college athletes have at one point received a prescription for narcotics.

In March, the Centers for Disease Control and Prevention issued new guidelines that dramatically cut how long patients can have access to this highly addictive class of drugs. The guidelines recommend prescribing lower doses and shortening availability to a maximum of seven days.

The reality is that all athletes are one fall, twist, or tweak away from landing their own opioid prescription. In the wake of our country’s pain pill epidemic and the CDC’s new guidelines, many physicians are beginning to think differently about this class of drugs. Matthew Sedgley, a doctor at MedStar Sports Medicine in Westminster, Maryland, who often works with runners, triathletes, and bicyclists, is sympathetic to athletes’ pain. “I get it,” he says, “and sometimes short-term narcotics are warranted. But we’ve got an epidemic, and I’m not adding to that.” At this year’s meeting of the American Medical Society for Sports Medicine, Sedgley learned that despite representing only four percent of the world’s population, the United States uses 80 percent of all the narcotics in the world.

Sedgley hasn’t prescribed a narcotic in the past four months and will consider the drug class only for acute, short-term cases. He instead attempts to help injured athletes with alternative approaches that don’t involve narcotics, like working closely with a pain management specialist, physical therapist, or acupuncturist.

This was Zeiger’s approach. She tried nerve blocks, cortisone shots, physical therapy, and acupuncture, but ultimately, movement helped the most. Swimming and cycling, Zeiger found, exacerbated her pain, but running (and walking, when running was too painful) offered some relief. Sedgley says pain relief via movement is not uncommon, because athletes tend to get stiff and achy when sedentary.

Research is emerging to support additional alternatives to narcotics. A recent National Institutes of Health study found that meditation can provide pain relief via a non-opioid pathway to the brain. Wen Chen, program director of the NIH’s Division of Extramural Research, says they believe mediation can effectively treat chronic pain. Such is the experience of Scott Weiss, clinical director of Bodhizone Physical Therapy and Wellness in New York City, who has worked with elite and amateur athletes for years and regularly prescribes meditation as an alternative pain treatment. Weiss says that half of the injured athletes he sees use meditation—of those, 80 percent report reduced pain. One of his regular meditation clients is 2012 Olympic fencer Daryl Homer, who first approached Weiss in 2014 for relief from a sports hernia. “People often find meditation hard to swallow, but with the right instructor, they can start finding relief in just one session,” Weiss claims.

Athlete and practitioner buy-in to alternatives is growing. Data from the 2012 National Health Statics Report shows a slight increase in most forms of complementary medicine over a similar report from 2007. Anecdotally, trainers and coaches seem to be reaching for nontraditional solutions sooner, says Jessica Sleight, an acupuncturist for Eastern Washington University.

Weiss has also begun advocating for marijuana as a step-down from opioids, something Baltimore Ravens offensive tackle Eugene Monroe is campaigning for within the NFL. “Research shows that cannabinoids are a safer, less addictive alternative to opioids,” says Monroe. But because marijuana is on the NFL’s banned substance list, Monroe says he and his fellow players have no option but to use opioids for pain.

Zeiger hopes the worst pain is now behind her. “It has been a very long road,” she admits, “and I consider myself fortunate not to have experienced any dependence on narcotics. Not everyone is so lucky.”

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